| NPI | 1649070061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NINA BUBALO Owner Dentist 408-466-4197 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2025-03-14 |
| Last Update Date | 2025-03-14 |